Kusemererwa Robinah,Memuna Mohammad
Uganda. 14-Dec-2024
Source:Kusemererwa Robinah
SUMMARY
The project "Economic Self-Development among Clients Living with HIV in Mbarara ART Clinic Facilities" addresses the economic hardships faced by individuals Living with HIV by integrating empowerment initiatives into HIV care. Recognizing the connection between poverty and HIV outcomes, the program emphasizes skills training, entrepreneurship support, microfinance access, and job placement to improve clients' financial resilience and treatment adherence. Globally and in Uganda, economic challenges such as unemployment and stigma exacerbate HIV vulnerabilities, with young people particularly affected. Research highlights that poverty undermines adherence to treatment, reducing viral suppression rates. By equipping clients with practical skills, business support, and financial literacy, the initiative aims to reduce financial barriers, improve health outcomes, and promote sustainable livelihoods and this align with the sustainable development goal of end poverty. A mixed-methods study will evaluate the program's impact through surveys and interviews, analyzing treatment adherence, income changes, and health outcomes. Ethical measures will ensure confidentiality, and data will inform sustainable solutions to intersecting economic and health challenges. This model has the potential to enhance overall well-being for HIV-positive individuals and can serve as a replicable framework for other contexts facing similar socioeconomic and health challenges.
BACKGROUND
On a global scale, efforts to combat the HIV/AIDS epidemic have increasingly emphasized the importance of addressing the socioeconomic determinants of health. Research has shown that poverty, lack of education, and limited access to economic opportunities exacerbate vulnerability to HIV/AIDS and hinder treatment adherence and health outcomes. The 2024 HIV/AIDS fact sheet showed that 80% of the new HIV infections were among the young people (15-24 years) and this could be due to lack of employment opportunities, but employment challenge becomes worse when they turn positive. In Uganda, a country significantly affected by HIV/AIDS, the integration of economic self-development interventions into ART clinic facilities is particularly relevant.
Despite progress in expanding access to antiretroviral therapy, many individuals living with HIV/AIDS continue to face economic hardships that affect their ability to manage their health effectively. By providing clients with access to vocational training, microfinance initiatives, and entrepreneurship programs, the project aims to empower individuals to improve their economic status and build sustainable livelihoods. By addressing the root causes of economic vulnerability, this initiative has the potential to enhance treatment adherence, reduce the risk of disease progression, and promote overall well-being among individuals living with HIV/AIDS in Uganda and beyond. The intersection of economic self-development and healthcare has garnered increasing attention as a means to address the multifaceted needs of individuals living with HIV/AIDS, particularly those with high viral loads.
Globally, the HIV/AIDS epidemic has posed significant challenges to public health systems, economies, and social well-being, particularly in low- and middle-income countries where access to healthcare services and economic opportunities may be limited. Efforts to integrate economic empowerment interventions into HIV/AIDS care and treatment programs have emerged as a promising approach to improve health outcomes, enhance resilience, and promote sustainable livelihoods among affected populations. Despite the fact that there’s no cure to HIV, viral load suppression minimizes the risk of HIV transmission hence the global target of 95% of clients on ART to be with suppressed viral load to end AIDS by 2023 (WAD Report 2020).
Research conducted worldwide has highlighted the complex interplay between poverty, inequality, and HIV/AIDS and Socioeconomic factors such as poverty, unemployment, lack of education, and gender disparities have been identified as key drivers of HIV vulnerability, particularly among marginalized populations. Individuals living with HIV/AIDS often face numerous economic challenges, including reduced employment opportunities, loss of income, and increased healthcare costs, which can further exacerbate poverty and social exclusion. Literatures show that HIV prevalence tends to be higher among socioeconomically disadvantaged populations compared to wealthier individuals(UNAIDS,2019). In response to these challenges, there has been increasing advocacy for the integration of economic empowerment interventions into HIV/AIDS care and treatment programs.
By addressing the economic needs of individuals living with HIV/AIDS, such interventions aim to improve treatment adherence, enhance health outcomes, and promote long-term economic resilience In Uganda, as in many other low- and middle-income countries, poverty and economic insecurity intersect with HIV/AIDS in complex ways. Limited access to healthcare services, stigma and discrimination, and inadequate social support systems contribute to the economic vulnerability of individuals living with HIV/AIDS, especially those with high viral loads who may face additional health-related challenges. According to the fact sheet 2021, Uganda has achieved a viral load suppression of 82% below the global target of 95-95-95. Due to lack of employment and low social economic status of people living with HIV, a number of HIV positive people have been discriminated in job companies including families that need family helpers and labour expose companies, leaving this population un employed and many have forged negative results while others stop their medication in the search for employment (Ugandan newspapers 2022)
At Mbarara regional referral hospital and other facilities in the city, clients living with HIV have stopped drugs and forged negative results in the search for jobs and this information is got during tracking after the client is lost to follow up in the clinic therefore strengthening Economic self-development among this population will help achieve viral load suppression. The main objective of this is to empower individuals living with HIV/AIDS, particularly those with high viral loads, to achieve economic independence and sustainability.
1.Empower clients with living with HIV increase their income levels in all ART clinic facilities
2.Enhance financial resilience among clients by facilitating the establishment of sustainable income-generating activities
3.Improve the overall well-being and quality of life of clients by reducing financial barriers to healthcare access and treatment adherence
The purpose of this study is to investigate the effectiveness of economic self-development interventions among clients with high viral load attending ART clinic facilities in Mbarara City, Uganda. The study aims to assess the impact of economic empowerment programs on clients' economic status, treatment adherence, health outcomes, and overall well-being. The research will employ a mixed-methods approach, combining quantitative surveys and qualitative interviews to provide a comprehensive understanding of the complex dynamics at play. Study Design: Quantitative Component: The quantitative component will involve a cross-sectional survey conducted among clients with high viral load attending ART clinic facilities in Mbarara City and this will be done through; Needs Assessment: Conducting surveys and interviews to understand the economic challenges faced by individuals with high viral loads in the Mbarara City area, including their skills, resources, and aspirations.
Skill Development Workshops: Organizing workshops or training sessions to equip participants with practical skills relevant to local job markets or entrepreneurial ventures. This could include vocational training in fields such as agriculture, crafts, or small business management. Business Development Support: Providing guidance and support to help participants start or expand their own businesses. This might involve assistance with business planning, marketing strategies, financial management, and accessing microfinance or small business loans. Job Placement Services: Facilitating connections between participants and potential employers in Mbarara City and surrounding areas. This could include organizing job fairs, networking events, or partnerships with local businesses willing to hire individuals with HIV/AIDS.
Financial Literacy Training: Offering workshops or seminars to improve participants' understanding of basic financial concepts, budgeting skills, and savings strategies. This can help them make informed decisions about managing their income and assets. Peer Support Groups: Establishing peer support groups where participants can share experiences, provide encouragement, and offer practical advice to one another. These groups can serve as valuable sources of emotional support and motivation. Access to Healthcare Services: Ensuring that participants have access to essential healthcare services, including HIV/AIDS treatment, counselling, and support services.
This may involve collaborating with local healthcare providers and community organizations to address barriers to healthcare access. Monitoring and Evaluation: Regularly monitoring the progress of participants and evaluating the effectiveness of program activities. This can help identify areas for improvement and ensure that the project is achieving its objectives. Advocacy and Awareness-raising: Advocating for policies and programs that support the economic empowerment of individuals living with HIV/AIDS. This could involve raising awareness about the rights and needs of people living with HIV/AIDS and advocating for policies that promote equal opportunities and combat discrimination.
Sustainability Planning: Developing strategies to ensure the long-term sustainability of economic empowerment initiatives beyond the duration of the project. This might involve building partnerships with local government agencies, NGOs, or private sector organizations, as well as exploring opportunities for income-generating activities that can generate revenue to support ongoing program operations. Adequate statistical power ensured by sample size calculation. Participants will be recruited using systematic random sampling from the clinic's patient registry. Inclusion criteria will include adults (18 years and above) diagnosed with HIV/AIDS and confirmed to have a high viral load.
The survey instrument will include standardized questionnaires to collect demographic information, socioeconomic status, HIV treatment history, medication adherence, health outcomes (e.g., CD4 count, viral load), and economic self-development indicators (e.g., employment status, income generation activities). Data collection will be conducted through face-to-face interviews conducted by trained research assistants. Strict confidentiality and ethical considerations will be ensured throughout the process. Statistical analysis will be performed using appropriate methods, including descriptive statistics, chi-square tests, t-tests, and regression analysis to examine associations between economic self-development indicators and health outcomes.
Qualitative Component: The qualitative component will involve in-depth interviews with a subset of participants to explore their experiences, perceptions, and challenges related to economic self-development and HIV/AIDS management. Purposive sampling will be used to select participants who represent diverse demographic characteristics, treatment experiences, and economic backgrounds. Semi-structured interview guides will be developed to explore themes such as barriers to economic self-development, facilitators of treatment adherence, coping mechanisms, and perceived impacts of economic empowerment interventions. Interviews will be audio-recorded with participants' consent and transcribed verbatim for thematic analysis. Data will be coded and analysed using qualitative analysis software (e.g., NVivo).
Ethical Considerations: Ethical approval will be obtained from the Institutional Review Board (IRB) or Ethics Committee of the research institution overseeing the study. Informed consent will be obtained from all participants prior to their participation in the study, with assurances of confidentiality and voluntary participation. Measures will be implemented to ensure the privacy and confidentiality of participants' data throughout the research process. Participants will be provided with information about available support services and referrals to appropriate resources if needed. Data Management: Data collected from surveys and interviews will be securely stored and managed in accordance with data protection regulations. Identifiable information will be anonymized to protect participants' privacy.
Data quality checks will be performed regularly to ensure accuracy, completeness, and consistency of the dataset. Limitations: The study's cross-sectional design limits the ability to establish causality or assess long-term outcomes. Self-reporting biases may affect the accuracy of data collected through surveys and interviews. The study's generalizability may be limited to the population of clients attending ART clinic facilities in Mbarara City and may not be representative of other settings or populations
REFERENCES
African Economic Outlook. (2023). Youth unemployment and health in Africa: HIV implications. AVERT. (2023). Tackling youth unemployment and HIV in sub-Saharan Africa. Economic Empowerment Global Network. (2022). Case studies on entrepreneurship and HIV care. Global Fund. (2023). Economic empowerment as a tool for improving ART adherence. Health Economics and HIV/AIDS Research Division (HEARD). (2023). Economic barriers to HIV care. Health Policy Project. (2021). Integrating economic empowerment into ART programs: Global evidence. HIV/AIDS epidemiology and socioeconomic impact. Harvard T.H. Chan School of Public Health. Mbarara University Research Institute. (2023). Addressing economic challenges in HIV treatment adherence NIH. (2023). Socioeconomic determinants of health outcomes in HIV/AIDS. PEPFAR. (2023). Sustainability of economic interventions in HIV care. Retrieved from PEPFAR. Poverty Solutions. (2024). Linking poverty alleviation to health improvement in HIV care. University of Michigan. Retrieved from Poverty Solutions. Uganda Ministry of Health. (2022). Progress report on viral load suppression and socioeconomic interventions. UNAIDS. (2019). The intersection of poverty, inequality, and HIV/AIDS. UNAIDS. (2024). Global AIDS Update: Fact Sheet. Retrieved from UNAIDS. UNDP. (2021). Sustainable livelihood approaches for people living with HIV. UNESCO. (2023). Youth economic empowerment and its role in HIV prevention. USAID. (2022). HIV and livelihoods: Innovations in economic strengthening. Watkins-Hayes, C. M. (2023). Research on poverty and HIV/AIDS intersections. University of Michigan’s Gerald R. Ford School of Public Policy. WHO. (2022). Strategies for integrating economic resilience in ART programs. World Bank Group. (2022). Addressing HIV and economic vulnerability in low-income settings.
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